Southern Society of Electroneurodiagnostic Technologists 

2012 SCHOLARSHIP INFO

2012 Scholarship information coming SOON!

 
The Southern Society of Electroneurodiagnostic Technologists, Inc.

SCHOLARSHIP AWARD APPLICATION

 

 

NAME:______________________________________________________________________

ADDRESS:___________________________________________________________________

____________________________________________________________________________

EMAIL______________________________________________________________________

Scholarship applying for:(please circle one)        IONM                   PSG                        EEG                                                                                                                                                                  

CURRENT SSET MEMBER?  YES_____ NO_____

 

BOARD REGISTERED?  YES______ TYPE?_____________NO______ If “NO”, do you plan to take registry exams in the future?  YES_____ NO______              

 

WHERE DID YOU OBTAIN YOUR PROFESSIONAL TRAINING? PLEASE INCLUDE LENGTH OF TRAINING?___________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

 

EMPLOYER NAME, ADDRESS AND TELEPHONE_________________________________

______________________________________________________________________________

______________________________________________________________________________

 

EMPLOYER COMPENSATES FOR MEETINGS?  HOW MUCH?_______________________

______________________________________________________________________________

 

BRIEFLY STATE WHY YOU SHOULD BE SELECTED FOR A SCHOLARSHIP AWARD AND HOW YOUR PATIENTS, LABORATORY AND HOSPITAL WILL BENEFIT FROM YOURSELECTION._________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

 

YOU MUST INCLUDE A LETTER FROM YOUR SUPERVISOR OR ADMINISTRATOR STATING THEY ARE AWARE OF YOUR APPLICATION AND WILL APPROVE TRAVEL FOR THE UPCOMING SSET MEETING IF YOU ARE AWARDED THE SCHOLARSHIP.

 

***APPLICATIONS MUST BE RECEIVED 35 DAYS PRIOR TO THE MEETING***

SUBMIT APPLICATIONS TO: FAX 434-799-2451 OR E-MAIL TO NEUROEDU@SSET.ORG

                                                                                                                                               MAIL TO : MARY MONDUL: 305 SHAMROCK DRIVE , DANVILLE VA 24541 

 



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